Head-down tilt lithotomy position and well-leg compartment syndrome: An international survey of current practice

Aim: Well-leg compartment syndrome (WLCS) is a serious complication of prolonged surgery in the head-down tilt lithotomy (HDTL) position associated with increased postoperative morbidity and mortality. However, there is a lack of awareness and clinical guidance regarding prevention of WLCS. The aim of this study was to assess current HDTL-related practices and occurrence of WLCS among a global cohort of clinicians. Method: An international online survey of clinicians was conducted between July and December 2023. Data analysis involved descriptive statistics, machine learning techniques and qualitative content analysis. Results: A total of 595 clinicians from 71 countries and 14 specialities participated. Most (98%) reported routine use of HDTL, 27% of whom did not implement any preventive strategies. ‘Leg rest’ was the most reported preventive measure (41%), commonly initiated after 2 or 3 h of HDTL (79%), for 10–15 min (56%). Overall, 170 cases of WLCS were reported by 21% of respondents. The majority reported unilateral WLCS (81%) following a laparoscopic procedure (63%) performed in HDTL (64%). Only 28% of respondents discussed WLCS during consent for operations in HDTL. Machine learning identified ‘duration of uninterrupted HDTL’ as a positive predictor of the occurrence of WLCS (p < 0.001). Content analysis demonstrated that clinician perspectives and practices regarding WLCS are significantly influenced by personal experience, mostly due to a poor evidence base and lack of standardized institutional policies. Conclusion: Perioperative practices during procedures in HDTL vary substantially, and are primarily informed by clinician experience and preferences. There is a need for evidence-based consensus on best practices to enhance safety during procedures in HDTL. © 2025 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

Авторы
Uzoma Chukwuemeka C. 1, 2 , Shepherd Anthony I. 1 , Saynor Zoe Louise 3 , Khan Jim S. 4, 5 , Piozzi Guglielmo Niccolò Niccolò 4 , Duhoky Rauand 4, 6 , Askew Christopher D. 7 , Ozmen Mahir M. 8, 9 , Middleton Thierry R.F. 1 , Masum Shamsul K. 10 , Perissiou Maria 1 , Goswami Aakansha Giri , Aziz Aamir , Elnour Abdolazeem , Ndong Abdourahmane , Hamid Abdul Fattah Bin , Khan Abdullah , Kulfi Abdullahi Musa , Mylonakis Adam , Adeyeye Ademola A. , Fuentes Adriana Liceaga , Mikneviciute Agne , Hassouneh Ala’ , El-Hussuna Alaa , Aregawi Alazar Berhe , Aiolfi Alberto , Arezzo Alberto A. , Herrando Alberto Ignacio , Vannelli Alberto , Malagnino Alessia , Julianov Alexander E. , Kozadinos Alexandros , Theodorou Alexis , Yildirim Ali Cihat , Guner Ali , Malik Ali , Mohamedahmed Ali Yasen Y. , Bulut Alisina , Antonelli Amedeo , Botros Amir , Mureb Amro Ahmed , Zakaria Andee Dzulkarnaen , Divizia Andrea , Guida Andrea Martina , Romanzi Andrea , Gumbs Andrew A. , Lynch Andrew Craig , Day Andrew , Marra Angelo Alessandro , Parello Angelo , Paspala Anna , Lin Anthony , Castaldi Antonio , Luberto Antonio , Laganà Antonio Simone , Koutras Antonios , Picciariello Arcangelo , Ioannidis Argyrios , Papadopoulos Aristeidis , Rashid Arshad , Kerawala Asad Ali , Marinis A.D. , Pantelis Athanasios G. , Syllaios Athanasios , Acheson Austin George , Saklani Avanish P. , Oladayo Ayandele Babajide , Kobalava Badri , Hemmelová Beata , Drago Beatrice , Yohannes Binyam , Sebastian Boby , Ratto Carlo , Gianmaria Casoni Pattacini , Guldogan Emir , Ciubotaru Cezar Ionut , Onyeze Chigozie Innocent , Agbo Christian , Bali Christina D. , Fleming Christina A. , Kontopoulou Christina I. , Chouliaras Christos , Benlice Çiğdem , Tatar Cihad , Akyol Cihangir , Coco C. , Peirce Colin B. , Nastos Konstantinos , Gallardo Cristián , Hüscher Cristiano Germano Sigismondo , Wright Danette , Wilby Daniel , Brogden Danielle Rebecca Louise , Verdi Daunia , Merlini David Alessio , Watt David , Pertile Davide , Burke Dermot , Markos Despotidis , Sasia Diego
Журнал
Colorectal Disease
Издательство
John Wiley and Sons Inc
Номер выпуска
6
Язык
Английский
Статус
Опубликовано
Ссылка
Внешняя ссылка
DOI
10.1111/CODI.70134
Номер
e70134
Том
27
Год
2025
Организации
  • 1 Clinical Health and Rehabilitation Team, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
  • 2 Department of Surgery, RUDN University, Moscow, Moscow Oblast, Russian Federation
  • 3 School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
  • 4 Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, United Kingdom
  • 5 Faculty of Health Sciences, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
  • 6 School of Computing, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
  • 7 VasoActive Research Group, University of the Sunshine Coast, Sippy Downs, QLD, Australia
  • 8 Mahir Ozmen Clinic (MOC), Ankara, Turkey
  • 9 School of Medicine, Sapienza Università di Roma, Rome, RM, Italy
  • 10 School of Mechanical and Electrical Engineering, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
Ключевые слова
compartment syndrome; global survey; Lloyd-Davies; perioperative practices; prevention and management; robotic surgery
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